Pupils also constrict when the surrounding light is too bright to avoid overwhelming your eyes. For example, younger individuals tend to have larger pupils than older people. Now that you know how to check PERRLA, be sure to document other descriptive findings clearly and in detail. What should pupils look like Normal pupil size ranges between 2.0 to 5.0 millimeters, and the size of the pupil can change due to a number of factors. If all the findings in pupil examination are normal, then it is usually documented and shortened as PERRLA which stands for pupils equal, round and reactive to light and accommodation. Some patients with an increase of intraocular pressure can undergo a pupil change that needs a series of examination. This type of pupil is called as the Argyll Robertson pupil.Įven though pupils have to be more or less the same size and shape, procedures such as lens implantation, iridectomy, or traumatic and congenital defects can cause a difference in shape. Lens accommodation cannot be observed but it can only be assumed.Īutonomic diseases for example due to syphilis or diabetes can cause the pupil not to produce any response towards light but able to respond towards accommodation. As a response, the normal pupil will constrict when the eye converges to focus on the finger of the examiner. It can be clearly observed by asking the patient to focus on an object at a certain distance and follow the finger of the examiner which is moved closer until it reaches the distance of 3 to 5 inches in front of the patient’s nose. Normal lighting can give you a normal pupil size of about 3.5 mm and 1.0 mm to 10 mm. The pupil will not react towards accommodation done by the lens but will constrict when the eye converges on a near object. If the patient can follow orders, the pupil reaction towards near vision and convergence can be examined. Slow response or no reaction at all can happen in the increase of intracranial pressure. On eyes that suffer from nerve injury, the direct light stimulation will not produce a pupil response, but on the eye that is not damaged, direct light stimulation will induce a response in the damaged eye. Exploration regarding this phenomenon will enable us to differentiate between blindness caused by optic nerve injury and blindness caused by a central disease. The consensual reaction is evaluated on both eyes. The presence of abnormal size could indicate a cerebral damage, while when the pupil has oval shape, it means that. For the shape, a normal pupil should be round. ![]() On the additional point, the pupils should be equal in size. Deriving Conclusions From Pupil ExaminationĪ constriction of the pupil that is stimulated is called as direct light reflex while the constriction of the pupil of the other eye is called as an indirect light reflex or consensual. Based on Bersten et al, 2003, the average size of pupils ranges from 2 mm to 5 mm.
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